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Scotter04

Depression/Adjustment disorder claim

Question

Hi All,

I've got a question about submitting a depression/adjustment disorder claim on ebenennies.

When I submitted the claim to include sleep disturbances and anxiety. Hit save and continue and the next page said I claimed Ptsd.  It gave me the option of answering the questions or not.  

So, is this typical for depression/adjustment disorder?  If so, do I answer the questions or if not, skip the questions?  Any help would be appreciated.

Hope everyone is having a great weekend.

Scotter

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Tough question so let me start with this. In order to be service connected for any disability you need three things. 1, A service connected event. 2. A bridge from that service connected event to your current disability. And 3. A current diagnosis of a disability. Now, there are exceptions to the above if you got out of service within the past year, or if the condition is presumptive, which mental health issues are not presumptive.

So, I would suggest filling out the PTSD questionnaire. Many people recognize they have depression or some other mental health problem, but lack the training to identify the source. Depression and anxiety can be disabilities in themselves, but they can also be symptoms of a more complex issue of PTSD.  

Lastly, did you suffer from a traumatic event while in the military, and is it recorded in your service records? If so, your symptoms may qualify for a PTSD diagnosis. If there is no traumatic event recorded in your service records it makes it harder, but not impossible to obtain a service connected disability.

One more point... If you submit a claim for PTSD you will also need to submit VA Form 21-0781 and 21-0781a. Failure to submit them both with your initial claim will remove you from the Fully Developed Claim program.

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LATEST UPDATE:

Had my C & P Exam the other day for Adjustment Disorder Secondary to my S/C'd Tinnitus.  The Examiner said it was more inline with Unspecified Anxiety Disorder and not the Adjustment Disorder my MH Doc said I had.  The Examiner wrote the Adjustment disorder as "The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service connected condition."  So my question is

So my question is...Obviously I still need to wait for the BBE but if/when I'm denied would I appeal and change the contention to " Unspecified Anxiety Disorder " or would I file a new claim under " Unspecified Anxiety Disorder secondary to my S/c'd Tinnitus"?

I have scrubbed and included my C & P Exam notes below.  Any feedback would be greatly appreciated.

 


                                Mental Disorders
                     (other than PTSD and Eating Disorders)
                        Disability Benefits Questionnaire  
   
    Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination Request?   [X] Yes  [ ] No

                          
    1. Diagnosis
    ------------
    a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)?
       [X] Yes  [ ] No
      
       ICD code: F41.9
      
       If the Veteran currently has one or more mental disorders that conform to
       DSM-5 criteria, provide all diagnoses:
      
       Mental Disorder Diagnosis #1: Unspecified Anxiety Disorder
       ICD code: F41.9
       Comments, if any:
         transient, moderately severe symptoms of anxiety (irritability,
         edginess, nervousness, panic symptoms with chest tightness, pressured
         breathing, sweatiness, heart palpatations, etc. that occur when he is
         around a lot of noise or when someone is hovering over him at his desk
         at work which makes him feel closed in, insomnia due primarily to
         tinnitus, muscle tension in back muscles, concentration/short-term
         memory problems, fatigue) that had onset after the military (approx 10
         years ago) and cause marked distress and mild impairment in
occupational
         and social functioning (due primarily to irritability and impatience at
         work and at home, fatigue, concentration/short-term memory issues)

    b. Medical diagnoses relevant to the understanding or management of the
       Mental Health Disorder (to include TBI): Obstructive Sleep apnea with
       C-PAP; Tinnitus
      

    2. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder diagnosed?
       [ ] Yes  [X] No
      
    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
       [ ] Yes  [ ] No  [X] Not shown in records reviewed
      
    3. Occupational and social impairment
    -------------------------------------
    a. Which of the following best summarizes the Veteran's level of
occupational
       and social impairment with regards to all mental diagnoses? (Check only
       one)
      
       [X] Occupational and social impairment due to mild or transient symptoms
           which decrease work efficiency and ability to perform occupational
           tasks only during periods of significant stress, or; symptoms
           controlled by medication

    b. For the indicated level of occupational and social impairment, is it
       possible to differentiate what portion of the occupational and social
       impairment indicated above is caused by each mental disorder?
       [ ] Yes  [ ] No  [X] No other mental disorder has been diagnosed
      
    c. If a diagnosis of TBI exists, is it possible to differentiate what
portion
       of the occupational and social impairment indicated above is caused by
the
       TBI?
       [ ] Yes  [ ] No  [X] No diagnosis of TBI
      
                               Clinical Findings:
                               ------------------
    1. Evidence Review
    ------------------
    Evidence reviewed (check all that apply):
   
    [X] VA e-folder (VBMS or Virtual VA)


    2. History
    ----------
    a. Relevant Social/Marital/Family history (pre-military, military, and
       post-military):
      
         States he was born and raised in Nebraska, raised by both parents, and
         he has 2 younger brothers and one younger sister. States he had a good
         childhood, denies any childhood abuse or neglect, and states he had
good
         social skills, had a good number of friends as he was growing, played
         basketball and football in high school.

         He entered the Air Force in August 1990, had no unusual trouble
         adjusting to the military.

         States he has been married twice and divorced once, first marriage was
         from about 1999 to about 2009, has 2 sons from the marriage (ages 12
and
         10), shares custody of both, sees them every other weekend, facetimes
         with them during the week. States he has been married to his current
         wife for 7 years, and they have a 5 year old son together. States they
         currently own their own in Brimerton Washington, wife and youngest son
         lives in the home currently and he is in San Diego for work (has been
         gone since March, was able to go back home for several weeks in
         August/Sept, will be done with his job in San Diego around Christmas).
         States his marriage is "good", has good relationships with his
children.
         States he currently has a couple of friends he works with in San Diego,
         sometimes hangs out with them after work, also has friends elsewhere he
         stays in touch with via facebook. States he contacts his parents about
         once a month to let them know how he's doing, only talks with his
         siblings about every other year when he goes back to Nebraska to visit.
         States he is active in his church, and he enjoys golfing, spending time
         with his family, and doing outdoor activities (camping, hunting,
         fishing, etc.).
        
        
    b. Relevant Occupational and Educational history (pre-military, military,
and
       post-military):
      
         Premilitary Hx: States he had no major behavioral or disciplinary
         problems, got pretty good grades in school, graduated from high school
         on time. States he worked as a fertilizer salesman for his father and
         for farmers in the area during high school.

         Military Hx: Entered the Air Force in August 1990, honorably discharged
         in Oct 1999. MOS/Rate was Fuels Journeyman, highest rank/rank at
         discharge was E4. States he was reduced in rank one time in 1995 due to
         DUI but states he was able to recover rank over time after the DUI. He
         denies any other formal disciplinary problems, was awarded an air force
         commendation medal, 2 air force achievement medals, 2 air force
         outstanding unit awards, 2 good conduct medals, national defense
service
         medal, armed forces expeditionary medal, 3 southwest asia service
         medals, overseas short tour ribbon, 2 air force longevity service award
         ribbons, NCO professional military education graduate ribbon, and air
         force training ribbon.

         Combat Exposure: in Saudi Arabia in 1992 and 1994, but no combat
         exposure

         Postmilitary Hx: States that after the Air Force, he worked in a
         warehouse for circuit city until 2001, then got a job as a material
         handler for the Navy, is now a material handler project manager (for 4
         1/2 years), states the job can be stressful, but he likes his job,
feels
         he is good at his job, performs well. States his wife is currently a
         medical assistant.  
        
        
    c. Relevant Mental Health history, to include prescribed medications and
       family mental health (pr
e-military, military, and post-military):
      
         States he has no family hx of mental illness that he knows of, and he
         denies that he had any mental health problems or psychiatric treatment
         prior to the military.

         States he was sent to mental health after his DUI in 1995, had 2-3
         appointments with mental health and then 2-3 alcohol abuse treatment
         sessions, was diagnosed with alcohol abuse, had no other mental health
         treatment during the military. States he and his ex-wife had couples'
         counseling/therapy in about 2008 (a couple of sessions), also had
         marital therapy with his current wife and individual therapy sessions
         due to problems with his ex-wife interferring in their relationship.

         He had a mental health intake at the Puget Sound VA in Nov 2015, was
         diagnosed with adjustment disorder and other sleep/wake disorder, and
         had 5 individual therapy sessions through the Puget sound VA after the
         intake. Intake note from the puget sound VA dated Nov 6, 2015 states
         "Veteran presented to this initial PCMHI intake reporting that he
         experiences initial insomnia as a result of tinnitus. He also endorsed
         waking up 2-3x/night, but indicated that he is usually able to fall
         asleep within 15 minutes. Altogether, he reported getting between 3-5
         hours of sleep, and he endorsed feeling tired during the day. He also
         complained of irritability, indicating that he feels easily annoyed and
         snaps at people both at work and at home. This has led to marital
         conflict. Veteran also endorsed difficulty concentrating, short-term
         memory difficulties, and depressed mood. He stated that he is "getting
         tired of the tinnitus, sleepiness, insomnia, and I'm frustrated that
         it's interfering with me and my wife's relationship." Veteran also
         endorsed anxiety, describing frequent panic attacks when in a crowded
         room. These panic attacks involve tightness in his chest, an immediate
         urge to escape, increase HR, sweating, hot flashes, feeling faint,
         nausea, and his "mind racing about am I going crazy or is it going to
         get worse." He reported that these attacks last from 5 min-1 hour, and
         he copes with them by "trying to analyze and wait it out." He also
         engages in deep breathing to slow his heart rate down. He is confused
by
         the appearance of panic attacks, which began 6-7 years ago and have
         increased in frequency." "Veteran endorsed struggling with insomnia for
         approx. 15 years and indicated that the other MH symptoms he endorsed
         have slowly developed over the course of the last 10 years or so. He
was
         previously prescribed zolpidem, which was somewhat helpful. However, he
         reported that it still took a while to take effect at night, so he
         discontinued it."

         States he continues to have difficulty sleeping, which he feels is
         primarily due to "continuous tinnitus" (although he has been diagnosed
         with sleep apnea and is prescribed a C-PAP machine, states the machine
         is not very helpful, admits that sleep apnea might play a part in his
         sleep disturbance). States he has had transient, moderately severe
         symptoms of anxiety (irritability, edginess, nervousness, panic
symptoms
         with chest tightness, pressured breathing, sweatiness, heart
         palpatations, etc. that occur when he is around a lot of noise or when
         someone is hovering over him at his desk at work which makes him feel
         closed in, insomnia due primarily to tinnitus, muscle tension in back
         muscles, concentration/short-term memory problems, fatigue) that cause
         marked distress and irritability at work (states work colleagues in
         puget sound have heard about his verbal outbursts) and states it does
         not take much for him to "snap" at his wife. 

        
        
    d. Relevant Legal and Behavioral history (pre-military, military, and
       post-military):
      
         States he got a DUI in 1995, was reduced in rank for the DUI, but he
         denies any other arrests or major legal or behavioral problems before,
         during, or since his service in the military.
        
    e. Relevant Substance abuse history (pre-military, military, and
       post-military):
      
         States he started drinking in excess in about 1993 (no excessive
alcohol
         use prior to the military), got a DUI in 1995, was reduced in rank for
         the DUI and sent to alcohol abuse treatment (3-4 appointments), states
         he continues to use alcohol, but he denies any excessive alcohol use
         since his DUI, denies that he drinks and drives, denies any other
         occupational or legal problems due to alcohol use, and he denies any
         other substance use  problems before, during, or since his service in
         the military.
        
    f. Other, if any:
       No response provided.
      
    3. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
    Veteran's diagnoses:
   
       [X] Anxiety
       [X] Panic attacks that occur weekly or less often
       [X] Chronic sleep impairment
       [X] Mild memory loss, such as forgetting names, directions or recent
           events
       [X] Disturbances of motivation and mood
       [X] Difficulty in adapting to stressful circumstances, including work or
a
           worklike setting

    4. Behavioral observations
    --------------------------
    The Veteran arrived at his exam appointment on time. He was dressed
casually,
    appears to have good grooming and hygiene, demonstrated no evidence of
    thought disorder or gross cognitive or memory deficits, made appropriate eye
    contact, and was cooperative and alert and oriented during the exam. His
mood
    and affect appeared euthymic and generally, and he denies any current
    significant depression or any history of suicidal ideation, suicidal
    gestures/attempts, or psychiatric admissions, also denies any history of
    homicidal ideation or intent, manic/hypomanic symptoms, or psychotic
symptoms
    (no auditory/visual hallucinations or delusions), and he demonstrated no
    behaviors consistent with these symptoms during the exam.
     
    The Veteran was given a brochure containing information about mental health
    and medical treatment resources for Veterans (includes suicide/crisis
hotline
    information) during the exam and was encouraged to seek mental health
    treatment through the San Diego VA if he feels treatment is needed. He was
    also strongly encouraged to go to the nearest emergency room and to call the
    suicide hotline in the event that he begins to have suicidal ideation in the
    future.
   
   
    5. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to mental disorders
    that are not listed above?
    [ ] Yes  [X] No
   
    6. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes  [ ] No
   
    7. Remarks (including any testing results), if any:
    ---------------------------------------------------
    ADLs: The Veteran reports that he is currently able to manage his own
    finances and other important activities of daily living (denies any current
    problems with personal hygiene/grooming, cleaning, shopping, cooking, etc.).
      
    Per Veteran's 2507:
    **CLAIM TYPE: ORIGINAL
    **SPECIAL CONSIDERATIONS: NOT APPLICABLE
    **INSUFFICIENT EXAM: NO

    ELECTRONIC CLAIMS FOLDER AVAILABLE.
    CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER.

    An in-person examination is required for the following exam(s). ACE process
    must not be used to complete the DBQ.

    DBQ PSYCH Mental disorders

    The following contentions need to be examined:
    ADJUSTMENT DISORDER

    DBQ PSYCH Mental disorders:

    Please review the Veteran's electronic folder in VBMS and state that it was
    reviewed in your report.

    MEDICAL OPINION REQUEST

    TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

    OPINION REQUESTED: Secondary Service Connection.

    Is the Veteran's ADJUSTMENT DISORDER at least as likely as not (50 percent
    or greater probability) proximately due to or the result of tinnitus?

    Rationale must be provided in the appropriate section. Your review is not
    limited to the evidence identified on this request form, or tabbed in the
    claims folder. If an examination or additional testing is required, obtain
    them prior to rendering your opinion.

    POTENTIALLY RELEVANT EVIDENCE:

    NOTE:  Your (examiner) review of the record is NOT restricted to the
    evidence listed below.  This list is provided in an effort to assist the
    examiner in locating potentially relevant evidence.

    Tab A (Federal treatment record in VBMS): Bremerton CBOC (Ajustment Disorder

    Diagnosis) dated 05/10/2016

    Tab B (Federal treatment record in VBMS): CAPRI Records -- Seattle VAMC
    dated 05/23/2016

    If more than one mental disorder is diagnosed please comment on their
    relationship to one another and, if possible, please state which symptoms
    are attributed to each disorder.

    Exam Findings:
    The Veteran was verbally notified that this evaluation is for compensation
    and pension purposes only and that he should see his treating clinician for
    regular psychiatric care.

    The Veteran's symptoms are not consistent with an adjustment disorder
    (symptoms not due to difficulty adjusting to a specific stressor). His
    symptoms are most consistent with DSM-5 criteria for a diagnosis of
    Unspecified Anxiety Disorder (transient, moderately severe symptoms of
    anxiety that had onset after the military/approx 10 years ago). His anxiety
    currently causes marked distress and mild impairment in occupational and
    social functioning (due primarily to irritability and impatience at work and
    at home, fatigue, concentration/short-term memory issues).

    The Veteran reports having sleep disturbance which he feels is due to his
    Tinnitus. Although his tinnitus likely plays a role in his insomnia, he has
a
    diagnosis of obstructive sleep apnea and does not find his C-PAP machine to
    be very helpful. He also has anxiety. It is my opinion that his
    insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excacerbated by tinnitus and his anxiety. 
   


****************************************************************************


                                 Medical Opinion
                        Disability Benefits Questionnaire

   
   
    ACE and Evidence Review
    -----------------------
    Indicate method used to obtain medical information to complete this
document:
   
    [X] In-person examination
   

    Evidence Review
    ---------------
    Evidence reviewed (check all that apply):
   
    [X] VA e-folder (VBMS or Virtual VA)


    MEDICAL OPINION SUMMARY
    -----------------------
    RESTATEMENT OF REQUESTED OPINION:

    a. Opinion from general remarks: **CLAIM TYPE: ORIGINAL
    **SPECIAL CONSIDERATIONS: NOT APPLICABLE
    **INSUFFICIENT EXAM: NO

    ELECTRONIC CLAIMS FOLDER AVAILABLE.
    CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER.

    An in-person examination is required for the following exam(s). ACE process
    must not be used to complete the DBQ.

    DBQ PSYCH Mental disorders

    The following contentions need to be examined:
    ADJUSTMENT DISORDER

    DBQ PSYCH Mental disorders:

    Please review the Veteran's electronic folder in VBMS and state that it was
    reviewed in your report.

    MEDICAL OPINION REQUEST

    TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

    OPINION REQUESTED: Secondary Service Connection.

    Is the Veteran's ADJUSTMENT DISORDER at least as likely as not (50 percent
    or greater probability) proximately due to or the result of tinnitus?

    Rationale must be provided in the appropriate section. Your review is not
    limited to the evidence identified on this request form, or tabbed in the
    claims folder. If an examination or additional testing is required, obtain
    them prior to rendering your opinion.

    POTENTIALLY RELEVANT EVIDENCE:

    NOTE:  Your (examiner) review of the record is NOT restricted to the
    evidence listed below.  This list is provided in an effort to assist the
    examiner in locating potentially relevant evidence.

    Tab A (Federal treatment record in VBMS): Bremerton CBOC (Ajustment Disorder

    Diagnosis) dated 05/10/2016

    Tab B (Federal treatment record in VBMS): CAPRI Records -- Seattle VAMC
    dated 05/23/2016

    If more than one mental disorder is diagnosed please comment on their
    relationship to one another and, if possible, please state which symptoms
    are attributed to each disorder.

 

 

    b. Indicate type of exam for which opinion has been requested: Mental
    Disorders

    TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE
    CONNECTION ]

    b. The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service
    connected condition.  

    c. Rationale: The Veteran's symptoms are not consistent with an adjustment
    disorder (symptoms not due to difficulty adjusting to a specific stressor).
    His symptoms are most consistent with DSM-5 criteria for a diagnosis of
    Unspecified Anxiety Disorder (transient, moderately severe symptoms of
    anxiety that had onset after the military/approx 10 years ago, and treatment
    records show he has had confusion about what the trigger for initial onset
of
    his anxiety may have been).

    The Veteran also reports having sleep disturbance which he feels is due to
    "continuous" Tinnitus. Although his tinnitus likely plays a role in his
    insomnia, he has a diagnosis of obstructive sleep apnea and does not find
his
    C-PAP machine to be very helpful. He also has anxiety. It is my opinion that
    his insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excacerbated by tinnitus and his anxiety. 


    TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR AGGRAVATION OF A
    NONSERVICE CONNECTED CONDITION BY A SERVICE CONNECTED CONDITI0N ]

    a. Can you determine a baseline level of severity of (claimed
    condition/diagnosis) based upon medical evidence available prior to
    aggravation or the earliest medical evidence following aggravation by
    (service connected condition)?  Yes

    ii. Provide the date and nature of the medical evidence used to provide the
    baseline:   It is my opinion that although tinnitus is not likely the cause
    of his anxiety or his sleep disturbance, the tinnitus likely
    exacerbates/aggravates his anxiety and insomnia beyond their natural
    progression. 

    *************************************************************************

 

 

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You need a nexus for service connection.  You can try an IME/IMO, but it wont fly until a doctor says your mental health disorder (list diagnosis, such as depression, PTSD, etc) is at least as likely as not due to xx event in military service. 

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UPDATE: Got my BBE yesterday and as expected DENIED.  I understand why I was denied and can live with it for now. My first issue is how can a Psychologist opine, during my C&P,  that my NSC Sleep apnea and the fact that my CPAP doesn't help that much is the cause for my Insomnia and anxiety. Would that type of Medical opinion have to come from a Sleep specialist?  

My second issue is: I'm mainly trying to get my insomnia and anxiety secondary connected to my tinnitus and that is what my VA MH Dr. is treating me for. So, in the following paragraph wouldn't this constitute a nexus for secondary SC to Tinnitus?

The Veteran also reports having sleep disturbance which he feels is due to
    "continuous" Tinnitus. Although his tinnitus likely plays a role in his
    insomnia, he has a diagnosis of obstructive sleep apnea and does not find
his
    C-PAP machine to be very helpful. He also has anxiety. It is my opinion that
    his insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excerbated by tinnitus and his anxiety.

 

One last thing I am in the process of sending of my FOIA for my C-File so do I send it to my RO (Seattle) or Janesville WIs?

 

Any and all responses will be greatly appreciated.

 

Scotter04

 

 

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    • By ThomasGray
      First off, hello and thank you in advance for any help that can be provided. Also, I apologize if something is not clear, trying my best to keep things concise.
      On Friday, May 15, I received letter from the VA, dated May 11, proposing a rating reduction from 100% to 70% for PTSD. The only evidence for the change listed is Rating Decision - Narrative(17SEP18) and DBQ PSYCH PTSD Review(06MAY20), whereas on my initial decision letter there was an abundance of evidence used. The major takeaway appears that my medical records(both prior to and after the initial rating, also from VA facilities) were not considered in this proposal. Is this normal?  
      I have yet to obtain the most recent C&P as I just received the proposal letter, but intend to attempt on Monday, May 18. Looking at the proposal letter though it seems that examiner didn't check a few specific boxes that were checked on my previous C&P. Other than that the differences appear to be minor. The two lists are as follows: Original C&P Gross impairment in communication Suspiciousness Depressed mood Suicidal ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Total occupational and social impairment Panic attacks (weekly) Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Flattened effect Panic attacks (less than weekly) Intermittent inability to perform maintenance of minimal personal hygiene Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Intermittent inability to perform activities of daily living Gross impairment in thought processes New C&P Forgetting names Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood Depressed mood Suicidal Ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Mild memory loss Forgetting recent events Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Panic attacks more than once a week Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Impairment of short- and long-term memory Flattened effect Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Forgetting directions I bolded the important items not that were not checked on the new c&p which led to the reduction proposal. It seems strange to me that new symptoms were added, however the very specific ones that would've caused the rating to remain the same all disappeared in just 1.5 years even though there is no noted improvement in my actual medical records.  
      What exactly is my next step? I have written a few statements of disagreement contesting the proposed reduction and pulled my VA medical records and will be getting a copy of the new C&P shortly. I have no idea were send the items as it is unclear in the packet. It says I have 30 days for one option and 60 days for the other. I don't think I need a notice of disagreement or start the appeal process as the final decision hasn't been made(this is a poorly worded question)?  
      Can I also request that they consider TDIU if the rating reduction is finalized or will I have to start a new claim for that? Should i send TDIU forms with my statements of disagreement and records?  
      I have been avoiding poking the bear and not filing claims for other conditions, some of which are caused by the various medications they have me taking, should I start filing claims for those as well?  
      And finally, if I do have to file for TDIU separately, should I start the claim now so that the date is saved? Do I submit the claim before or after I receive the final decision on the proposal? Sorry for the long post. I'm lost as to what to do next. It took me over 5 years of being denied before they would actually service connect anything and now this. Thanks again for any help, it is appreciated.
    • By Wise Guy
      I have a current claim for several injuries to include PTSD. I did some research and found out the best way of getting a rating for migraines is to have a diary through the VA of the migraines. For my PTSD which I got diagnosed through the VA in February, I'm taking Doxazosin (Nightmares), Hydroxyzine (Anxiety), and Sertraline (Mental Health). All of the medication causes headaches. However, the Sertraline only causes headaches within the first 2 weeks. I was going to wait until the claim was complete before filing for Migraines because I wanted to already have the rating for PTSD first so I can claim the migraines as secondary. But is there a way to still file for it now to still say it's because of the medication for the PTSD? Which route should I go or is there a better one? And should I talk to my VA counselor/medication doctor to get him to state that my migraines are caused by my PTSD and medications? I heard every time you file for a new claim, then everything gets re evaluated so it would be ideal if there was a way to get everything done now. 
       
      Also, I did get diagnosed through the VA for Sleep Apnea back in February,. So, can I say that the migraines was also caused by the Sleep Apnea?
    • By Jerry E
      BACK PAY:  Does  VA give retro back pay all at once or do they break it down...I used a va retro calculator and in low end and high end scenarios I came up with $40,000 plus....7 year back pay on one condition 5 years on another..long story short called VA because after waiting 2 plus weeks from receiving award letter they stated I had a payment of only half that being scheduled for this week couldn't give any info on any future if any payments 
    • By Michvetinfla
      I found your website. I have never posted anything asking anyone about this but I'm finally doing something about it and desperately need some advice. 
       
      The question specifically has to do with my physical exam at MEPS and the presumption of soundness attached to it. If I am found 100% physically fit and did not have to sign any waivers, how can I have a disability existing prior to entry discharge for a physical disability not previously noted at MEPS or in any previous records? Am I correct that unless otherwise noted at my MEPS examination, any physical injuries thereafter besides something congenital had to have occurred in service? As in nothing was noted for me other than I was in 100% perfect physical shape. Secondary question will be about how to connect the dots with my disability and future appointments and what I should be looking for in responses from doctors which I will go into further below. 
       
      Background information  
      I am sorry if this gets lengthy or the wrong Forum to put it at but I really don't know who else to ask and have never told my story or asked any advice from anyone about this.
       
      My entire life I knew I was going to be a marine and that's all I wanted to be as my grandfather was a World War II Marine veteran my father an army veteran so I knew and trained for very young to be a Marine it was my hopes and dream. I was a high school sport standout in every sport, won the state championship football perfect physical health ( I am 6 foot 4 inches 180 lbs) the plan was to go to college then be a Marine Corps officer. This was 1988 when I graduated high school, by 1989 I was in college not enjoying it and watching the Middle East get very hot. After discussing it with my father I had his blessing to drop out of college at Eastern Michigan University and enlist in the Marine Corps. I did the Delayed Enlistment program and they actually called me up early and reported in November 1990 to Camp Pendleton California. I will mention that I got a perfect score on the ASVAB by the recruiter and offered any job and I chose and signed a contract for intelligence with a Meritorious Promotion to private first class after graduating boot camp and Lance corporal after graduating my MOS School and upon graduating my MOS school and also a $10,000 bonus. Again just establishing my sincerity and fortitude that this was my dream and purpose I had trained for my entire life And I wouldn't be signing a contract adding time to my enlistment if I truly wasn't planning on making a career of the Marine Corps. 
       
      Boot camp In the Marine Corps is very stressful and  it was during the very beginning of the Gulf War. Needless to say to drill instructors were hyper-vigilant in one of them even got busted from our platoon for striking some of the recruits. I am only mentioning these boot camp incidents to establish a fact. Anyone knows in boot camp unless you are on your deathbed you do not report to sickbay. I was the same way but then again I was always healthy in my entire life. In second phase my feet started hurting when we would go on marches and humps and by the time we went back for third phase in San Diego I did report to sick call. I did miss the final March because my feet and lower legs hurt too bad pins and needles numbness pain Etc and it is in the boot camp medical records that this did happen and I did go to sick call. If I recall while in bootcamp I just was on light duty for a few days and we were so close to graduating I only missed a few days and graduated with my platoon. Throughout my entire boot camp I went to Sick Bay sick call the one time for my feet they put me on light duty I missed a few days of training and that was it and I graduated February 1st 1991 with my original  platoon I started with. I also had a final physical fitness test score of 299 out of 300. I was perfect in Pull-Ups, sit ups and the 3 Mile Run was 10 seconds short. I had one point subtracted because I was 10 seconds over the 18-minute mark, I'm saying this to establish I was in perfect physical health otherwise besides my feet and legs being so sore and painful. 
       
      Went home for boot camp leave reported back to Camp Pendleton for Marine combat training  (MCT). I was told that we had to pull guard or KP duty until space was available in the class. While in this holding platoon, doing guard Duty, the same problems occurred with my feet as they were tingly numb painful and this was after just standing post. And so I went to sick call for the second time in my life praying and hoping they would just give me some pills or something to alleviate the pain so I can go back to being a Marine. They took some X-rays put me on light duty and told me they will be back with me to see me again. 2 Days Later I am pulled into the office and told point blank that I am being discharged because I have mild bilateral pes planus or the common name flat feet and that this disability existed prior to entry into the service. And that was it! I can't even explain in words how my whole life I had been training and wanting to do this one thing and it was taken away so quickly in the blink of an eye and I had no recourse or way to get my Marine Corps career back. I was devastated. 
       
      At that moment I had no clue what to do as I have said my entire life I want to be Marine and by simply reporting to sick call and having some feet pain and leg pain I am all the sudden being discharged and my whole world ended. I must include this side note below.
       
      At Camp Pendleton that day being told the horrific news there was a Vietnam veteran nurse who was assisting me. She could tell how I couldn't believe this was happening I told her I never been sick or have flat feet or problems my entire life, in bootcamp I went to sick call one time and now one time here and now I'm being discharged I was beyond upset and couldn't figure out what to do she said there was nothing I can do, the medical board is already underway. Then she did something I don't know if it was legal or not but she could tell I was upset pissed off I just was so mad I told her I didn't care what anyone did at this point she said I'm going to do something I've never done and handed me all my x-rays (she handed me everything in the original color coordinated huge folders, mine are orange, with all the Navy markings on it) The Originals as well as the original radiologic consultation request report and prognosis for all those x-rays. She told me I know you don't care about any of this right now and you're very upset and have just seen your whole life flash before you (because I did tell her I had intended to retire a Marine), but twenty or thirty years down the road maybe even sooner you are going to need medical help because I've seen your records and you had no waiver entering service stating that you had these medical problems previously and this was caused while in service and they are claiming you had it before you enlisted so you do not get any VA benefits, but I did not see it on any of your records.  I'm giving you your original X-rays and the consultative reports and please hold onto them until you're ready to file for disability some time in the future, these will be your key, if you don't have these you will never see them again and it will make your claim almost impossible, the VA will contend it did not pre-exist, but these will prove it for you, she reiterated in the most passionate way that I must not lose those that I will need them to file a disability claim in the future.
       
      So fast forward until present day. I did save the original X-rays and the consultation report and have them in a safe place. It has taken me until a few months back to actually pull them out, look at them along with my discharge papers and realize that this is all wrong and I have a claim here! The evidence that I have is that the radiological report says as follows
       
          "left foot, 3  views: mild pes planus. 
       right foot, three views: mild Pes planus. " 
       
      Second consultation report from the radiologic consultation is
       
       "right lower leg, two views: possible stress fracture proximal tibia
       
       left lower leg: possible stress fracture left proximal tibia
       
       right foot, three views: hallux valgus deformity, otherwise within normal limits.
       
       left foot, three views: degenerative changes in the MP joints.
       
      What does this all mean to me and my ability for a VA claim?
       
      So move forward to current day unfortunately since I left the Marine corps I never have had any health insurance had a plethora of problems. In 2017 after years and years of back pain lower back pain ( as well as my feet and lower legs the entire time since I left the Marine corps) I finally went to a doctor and complained I was in so much pain something had to be done and he ordered an MRI.  I do have an MRI establishing my s1 – l5 lower back an S5 through s1 does have sacral nerve damage bulging and deteriorating disc etc enough to meet the classification for social security disability. The MRI was in 2017 and my lower back pain has been with me since I was in the Marines. I may have had three or four emergency visits and some urgent Care but there has not been any paper trail or evidence that a normal person would have 20 to 30 years of it I have almost nothing because I never went to the doctor or hospital.
       
      The catalyst that started this was in August 2019 I had a bicycle accident I broke my scapula in five places. I had no insurance I went to the emergency room they x-rayed it said yes it's a terrible break and gave me the number of a doctor who sees patients without insurance or money. As it turns out the man retired and no one replaced him. I called every resource clinic site et cetera… they had no one to look at my shoulder for without having insurance. I never had any follow up. After being out of work 9 months and realizing it's going to be a full year I will meet the requirement for SSI disability then upon seeing the one piece of medical evidence I possessed my MRI and its prognosis I asked a doctor and yes, it appears I do meet the listing for that with my 2017 MRI, not even taking into account the new injury and the further damage it has done. The point is that it is now 2020 and I have never had a follow-up appointment for the shoulder and obviously the shoulder is horrible but the back is even much worse now after the accident than before my 2017 MRI. With this knowledge and the fact that I do not have barely any evidence I knew if I filed for SSI disability they will send me to a local doctor to verify my injury and give me a NEW MRI which should show that is is even worse now than in 2017, which was physically bad enough to qualify then, it should be more than bad enough in nature to qualify for disability now. My research into SSI disability I kept seeing about veterans and that is how I return to my discharge papers and looked at them, and am planning and filing for VA disability.
       
      I have read about obviously I need documentation to prove any of this, VA especially and I have almost none, that is my main concern.
       
      I have read a little about pyramiding and primary injury secondary at cetera.
       
      My end result of filing for VA disability in this case will be to try and achieve 100% disability. In my research it may be possible but I will put down what I am thinking now.
       
      Because of the presumption of soundness and I had no waivers they cannot deny that the mild pes planus and bunions and the other damage listed in the X-rays I had for my medical board could not have existed previous to my service in the Marine corps or else it would have to have been noted at m e p s or I would have had to have had a waiver.
       
      My VA Claim thought process?
       
       The rating for mild pes planus is 0%, after review, mine is pronounced bilateral pes planus a 50% rating (my feet have gotten terribly worse over the years, my feet truly are flat as a pancake now pronating inward and very painful, has changed my gate, this is not official as I've never been to a doctor, but this is my honest opinion). Since this had to have happened in service this will be a primary injury I believe as well as the bunions or hallux valgus deformity. They are noted in my 1991 medical x-rays so as a primary I can safely say they have gotten much worse and both toes are affected now not just the right. The rating for bilateral hallux valgus is 10% each foot or a total of 20%. Bringing the total to 70% rating. Of course that is if I am awarded the  maximum for the bilateral pes planus and both feet hallux valgus.
       
      Now this is where I have some more questions?
       
      I also have all the symptoms and am very positive I have peripheral neuropathy which I'm very familiar with as my mother has it but, but the rating for that looks like it can be deemed secondary cause from my pes planus. If correct shouldn't I receive x% for bilateral peripheral neuropathy as a secondary result from my primary injury?
       
      Next,is tying in the primary pes planus to my SSI disability case that my lower back secondary (sacral nerve, herniated discs, degenerative disc disease) is aggravated and hurt from my primary bilateral pes planus as well as my bilateral neuropathy affects it as well. The listing for lower back pain is x percent up to a 100%
       
      And lastly the whole affair has caused me PTSD and that rating is 0% to 100% rating. I don't want to go into how I have it or not but I have read all the symptoms and can present a very strong case that I definitely have had PTSD since the day I was told I was being discharged. And with no insurance I have never gotten it treated but I have definite evidence of it in my life.
       
      I filed the SSI disability last week and am awaiting them to call me and set up a doctors appointment. I also called the veterans administration about filing disability. I called my local VA and ask about a veteran's service officer who could help me with filing questions.
      I started to go over some basics in my case and when PTSD was brought up he inquired how I could have it without being in combat and only in the service six months and I immediately shut down and felt that it was horrible a veteran service officer would make me feel as though I don't have valid reason to have PTSD. So that is why I searched the internet and found this forum.
       
      So another question since how do I establish PTSD?
       With no insurance can't really get a counseling thing even as a veteran I tried and since I was not in 2 years I did not qualify for any health benefits. I guess should I call the veterans hotline PTSD number and tell them I am suicidal just in order to get this documented and at least someone would have a file then from the VA about whatever I tell them my story?
       
       Also should I be trying to find my own doctors who would be favorable to my situation, and to further explore the tibia stress fractures and if I can associate that injury to another rating?
       
       I don't have insurance but I might be able to find a clinic, and my thought process is a podiatrist who will substantiate my pes planus condition. Should I be actively looking for a civilian doctor who will know the whole story I just recited and work with me to try to get my VA disability? 
       
      Or should I just file my claim with just the limited information (presumption of soundness) the x-rays that I have from 1991 and prognosis and hopefully my SSI disability case once I see the doctor who will also have some more evidence, hopefully providing more evidence of my infirmaries?
          
      Also is a question that would I be getting any kind of back pay disability for all these past 30 years if the decision is in my favor?
       
      Another question is that should I contact a lawyer? Also a veteran service officer should I contact someone like the American legion or which one would someone recommend I use because I truly do not know what I'm doing and I feel if I had the right direction I'm someone who knows all the intricacies and workings of the VA if I filed this correctly the first time and knew what type of evidence to gather it would make my claim so much more positive in my favor. if I have to, I will get the money somehow,a loan from family to see the right doctor but should I be going to a doctor, a veteran Dr who will be in my corner and spend money on it before I file this claim?
       
      Thank you everyone, I'm sorry if I'm rambling, I have many questions but I've already asked too many. I am grateful for finding this forum and I really hope someone has some real answers for me that can assist me. Thank you.
       
      Happy Easter!
       
      Sincerely,
      Marine from MI living in central FL now.
    • By nckingmatt
      Recently I have finally decided to seek help for my PTSD. Since I got out of service almost 10 years ago I have seen the shrink on the civilian side twice. I was diagnosed with PTSD but stopped going. I was even prescribed meds but never took  them out of fear. Today, I finally decided to get real help this time. During my PTSD with the VA PA. She told me that I scored really high on the PTSD screening and that she would set up a C and P exam for me. That someone would call to set up the appointment. I checked my health summary on myhealthevet a day after my phone screening. She Added "Acute stress reaction ICD10 F43.0 with Provider Comments: Acute Stress Reaction" 
      Can someone tell me what this means? Ive been diagnosed by civilian doctors for PTSD and she writes "Acute Stress reaction".. 
      She said she could not diagnose PTSD but she was a counselor. I am confused by this. Is she basically saying Im lying or is this normal?
       
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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    • Mere speculation in your VA C and P exam

      M21-1, Part III, Subpart iv, Chapter 3, Section D – Examination Reports III.iv.3.D.2.r. Examiner Statements that an Opinion Would be Speculative Pay careful attention to any conclusion by the examiner that an opinion could not be provided without resorting to mere speculation (or any similar language to that effect). VA may only accept a medical examiner’s … Continue reading
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      A favor please - just changed servers so if you have a moment go to https://www.hadit.com I'd like to see how the server handles a lot of traffic. So if you have a moment click the link and i can see how things are going on the back end.
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    • It's time to ask for help from the community. If you can help with a gift it would be very appreciated.

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